A nationwide survey has revealed that cardiothoracic surgeons in the country are still continuing with traditional methods despite a new technique being more effective in the longer run.TNN | September 08, 2015, 16:23 IST

HYDERABAD: A nationwide survey has revealed that cardiothoracic surgeons in the country are still continuing with traditional methods despite a new technique being more effective in the longer run.

If a surgeon performs the standard coronary artery bypass graft (CABG) surgery on a heart patient, which involves using an artery of the chest wall and an artery from the leg for grafts, there is a possibility of a need for re-surgery in 10 to 20 years.

In contrast, the chances of a re-surgery comes down to less than 3% cases and less than 5% cases in 10 and 20 years time respectively if the surgeon opts for Bilateral Internal Mammary Artery (BIMA) grafting, which involves using an artery each from the left and right chest walls. A re-surgery, on an average, costs Rs 50,000.

These findings were arrived at through a nationwide survey among 92 cardiothoracic surgeons from 75 medical institutions across India in the March-June 2015 period.

"What's most shocking is that despite its advantages, the study finds that only 5-10% Indian cardiac surgeons are performing BIMA while the majority 90% still prefer the traditional CABG," said Dr Lokeswara Rao Sajja, while releasing the results of the survey.

Quoting studies on BIMA published in international journals like Thoracic and Cardiovascular Surgery and The Annals of Thoracic Surgery, Dr Rao, a member of the American association for thoracic surgery, said that longevity of patients was found to increase when compared to the conventional CABG technique.

However, doctors in Andhra Pradesh and Telangana reportedly perform CABG on 8,000 cardiac patients annually, but not BIMA where the graft lasts longer! "The reason for not opting BIMA is a misplaced belief that it leads to infection and increases the operative time for a patient, but it is not entirely true. The rate of infection is more or less the same as in the conventional method, but the operative time needed in BIMA is slightly more. Say, if the traditional CABG technique takes 4 hours of surgery, a doctor would need 15 minutes more," said a doctor.

But Dr MSS Mukharjee, director, department of cardiology, Maxcure Hospitals, Madhapur, said that even globally, doctors have limited BIMA technique to not more than 10%. "While it is true that BIMA is ideally better, and should be performed wherever possible, more expertise is needed to perform it. There is also an element of fear that it's complicated, which explains why its rate is less," he said.

Only in India the healthcare financing is very small when compared to the financing by the other forces rather than the patient himself or herself paying out of pocket. Having 70-75% of the expenses as out-of-pocket, in my opinion, is not a right approach to managing healthcare in a country where the patients tend to sub-optimally purchase healthcare if he/she has to pay out-of-pocket.